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What Care Models Have Generalists Implemented to Address Transition from Pediatric to Adult Care?: a Qualitative Study

  • Laura C. HartEmail author
  • Mary S. Mouw
  • Randall Teal
  • Daniel E. Jonas
Original Research

Abstract

Background

The transition from pediatric to adult care is a critical period for young adults with childhood-onset conditions. General internists are tasked with participating in the care of this vulnerable population. Existing guidelines regarding transition do not fully address structural or organizational characteristics of practices that facilitate transition. Moreover, literature regarding transition has focused on pediatric subspecialty settings, leaving internists with little guidance after transfer.

Objectives

To better understand post-transfer transitional care by describing care models that primary care providers have implemented, and examining common features of generalist physicians’ experiences providing transitional care.

Design

Qualitative methods, semi-structured interviews.

Participants

Nineteen generalist-trained physicians from across the USA, engaged in transition-focused and/or ongoing care of adolescents and young adults with childhood-onset conditions.

Approach

Content and grounded theory analyses.

Key Results

Participants included nineteen physicians from seventeen institutions. Most (89%) were from academic medical centers. About 80% had completed a combined internal medicine-pediatrics residency. About 70% worked with clinic staff who were dedicated to transition. Practice structures fell into four main care models: (1) primary care in adult settings; (2) transition support and primary care in pediatric settings; (3) a blend of pediatric and adult care elements forming a bridge during transition; and (4) a transition consultative service. Most provided primary care for adults with childhood-onset conditions within larger adult-oriented primary care practices. Common features across interviews included taking extra time with patients both during and between visits and an interdisciplinary team-based approach. Shared practice strategies and philosophies emphasized care coordination, focus on the whole patient beyond immediate health concerns, and willingness to learn from practice and from families.

Conclusions

Participants used disparate care models. Common features and strategies among interviews highlight key functions and attributes of transitional care across settings, suggest important elements of care post-transfer, and clarify the role of generalists.

KEY WORDS

transition to adult care young adult health care models qualitative research 

Notes

Acknowledgments

We thank Dr. Mark Holmes, Director, Cecil G. Sheps Center for Health Services Research, for generous financial support, Dr. Don Pathman, Director, UNC’s NRSA Primary Care Research Fellowship, for invaluable mentorship, and the participating physicians for sharing their time, insights, and enthusiasm for this research.

Funding Information

The project described was supported by the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health, through Grant Award Number UL1TR001111. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Compliance with Ethical Standards

This study was deemed exempt by the University of North Carolina at Chapel Hill IRB.

Conflict of Interest

Dr. Hart was supported by NRSA grant number T32-HP14001 while completing this work. Dr. Mouw was supported by UNC Lineberger Cancer Center’s Cancer Control Education Program, 5R25CA057726-24. All remaining authors declare that they do not have a conflict of interest.

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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Laura C. Hart
    • 1
    • 2
    Email author
  • Mary S. Mouw
    • 3
  • Randall Teal
    • 4
  • Daniel E. Jonas
    • 1
    • 2
  1. 1.Department of Medicine University of North Carolina at Chapel HillChapel HillUSA
  2. 2.Cecil G. Sheps Center for Health Services ResearchUniversity of North Carolina at Chapel HillChapel HillUSA
  3. 3.Division of Geriatrics, Department of MedicineUniversity of North Carolina at Chapel HillChapel HillUSA
  4. 4.Connected Health Applications and Interventions (CHAI-Core)University of North Carolina at Chapel HillChapel HillUSA

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